16d • Vet Cases⚕️
🐾 Case Study: Why Did Duke Collapse at the Dog Park?
Meet Duke, a 6-year-old Doberman Pinscher who collapsed mid-run at the dog park. His owner describes two prior episodes of sudden weakness that resolved within seconds. Today he made it to the clinic.
On exam, his heart rate is 210 bpm. The rhythm is chaotic and impossible to count consistently. You notice multiple pulse deficits when you simultaneously auscultate and palpate his femoral pulse.
The ECG tells the story: no P waves anywhere, a wildly irregular baseline of fibrillation waves, and narrow QRS complexes firing in no predictable pattern. Atrial fibrillation with a rapid ventricular response.
Chest radiographs confirm what you suspected: a severely enlarged heart with early pulmonary edema. Duke’s dilated cardiomyopathy has progressed.
Your first move? Diltiazem 0.15 mg/kg IV slowly to rein in that ventricular rate. Then furosemide for the fluid.
You cannot convert Duke back to sinus rhythm. The goal now is control.
💡 The takeaway: In atrial fibrillation, rate control is the mission. Conversion is not the goal.
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🐾 Case Study: Why Did Duke Collapse at the Dog Park?
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